Health Committee on Oct. 24th, 2011

[Patricia Clark]

We do some work with aboriginal groups as part of our coalition. We know there is a much higher percentage of diabetes in aboriginal groups, both on reserve and off reserve, than in older adults in Canada. We know that it links back to their lifestyle. There certainly are genetic issues, but looking at type 2 diabetes, we know that lifestyle and the environment they're in need to be addressed in order to help manage and prevent it.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Mrs. Clark, you think that mental health issues should be considered before physical health concerns. Do you think that the government should have a national action plan for mental health?

[Patricia Clark]

I think mental health has to be addressed, and I can see that it's becoming more of an issue. At the preparation for the UN summit, I was sitting in a meeting and they were saying that we have to look at mental health. I don't think it's in isolation. All the issues of chronic disease should not be isolated, because so many of the realities of why people have chronic diseases are based on the same issues. You can easily have one and the other, so I would not want to say that we should just deal with mental health and nothing else. But it needs to be evident that we have to address mental health at the same time, if not before. Otherwise we will not have success from a prevention perspective.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

My next question is for Mr. Racine.

You told us about three specific cases involving francophones. Would you have more general information about the situation of francophone seniors in Canada living outside Quebec?

[Jean-Luc Racine]

We have data and the statistical profile. You can find this statistical profile of francophones in Canada if you go to the federation's website. Curiously enough, the health indicators show first that the francophone seniors are much more disadvantaged when it comes to their income than the general population, even in Quebec. Also, studies have been done, and it seems that there are more francophone seniors who are single, separated or who live alone than in the general population. We also have other indications that the education level of the francophone population is lower.

So we know that these francophones are, to some degree, much more at risk. Naturally, there is work to be done in that respect. So we need prevention services, which is what my colleagues have strongly insisted on. I think we must not be afraid of speaking to target clienteles. You just spoke about aboriginals, who are a target clientele under the federal government's responsibility. I think the government must play an important role in this respect.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Do I still have some time?

[The Chair, Conservative, Joy Smith]

We're almost out of time.

Does anyone else want to make a comment on Dr. Morin's question? No?

I'm sorry, our time is up, Doctor.

Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

I'd like to just touch on what we were discussing before with CIHR, on dementia and Alzheimer's. I know this committee has taken an interest in neurological disorders, and a few of the previous speakers have talked about it being a major factor in aging. I think it was estimated that there are 500,000 Canadians who have Alzheimer's. I know one of the mandates that you had for your strategic priorities was cognitive impairment.

What are your findings so far? Is there anything you've identified that can delay onset or that can better equip Canadian seniors to live with this insidious disease?

[Dr. Yves Joanette]

The international strategy for Alzheimer's disease is called international, but it's not only international: it fosters, of course, Canadian research that is excellent in different areas of the country, because we want to network better in order to get synergy among Montreal, Vancouver, Toronto, Halifax, and all the cities where there is good research on all aspects of Alzheimer's disease.

You're right, it's half a million now. It's going to be 1.2 million in about 10 to 15 years. And to give you figures that are mind-blasting, in about 15 to 20 years the number of people with dementia and Alzheimer's disease in China will equal the population of Canada, around 30 to 35 million people. So this is really a major challenge.

The research is on two fronts, I would say. The first one is to really identify and try to understand what the early markers of Alzheimer's disease are, because at this point there's no curative to offer. So there's lots of research there, and research is at the levels of genomics, biochemistry, and cognitive disorders. There is imaging that can be at the level of these biomarkers, and there are now more and more results that point first to the fact that it's more complex than it appeared to be initially, and that we have to pursue. But I think there's a little bit of light at the end of the tunnel, and we're starting to get some results, although none that are applicable tomorrow morning. Maybe they'll be applicable in five years.

The second front involves trying to strengthen the brain in order to resist the clinical manifestations of Alzheimer's disease for as long as possible. This does not diminish the disease, but makes it shorter. If you can delay by two, three, or even four years by using these lifestyle activities we refer to, then you have a major gain, and this is already available and starting to be implemented.

[Patrick Brown, Conservative, Barrie, ON]

I read somewhere, was it $8.6 million that Canada through CIHR was investing in Alzheimer's research? Is that allotment part of this international protocol?

[Dr. Yves Joanette]

CIHR is supporting research-initiated studies to a level.... I can tell you in a minute. Certainly the strategy is $25 million over five years, and we want to partner with other caritatifs, with provinces, and also with industry in order to double this money.

[Patrick Brown, Conservative, Barrie, ON]

There's the partnership with France and Germany and the U.K. Is CIHR doing any independent research aside from that?

[Dr. Yves Joanette]

Oh, sure. The majority of the research is done in Canada and supported through researchers here. There is some extra money put into a strategy to link internationally, because the question is so complex that we have to learn from others. So there are connections in Europe, connections in Asia, and connections also with the United States. These are the three pods, so to speak, of this international connection at this point, and Canadian researchers are leading in this.

[Patrick Brown, Conservative, Barrie, ON]

Do you believe that we have adequate resources right now for Canadian seniors who have Alzheimer's in terms of long-term care capacity, of living conditions for seniors? I think of my own riding, Barrie. I know that the wait list is quite long for long-term care. One home, Grove Park Home, has a five-year wait list, and I'm sure that's common.

What types of concerns do any of you have in terms of the wait lists for people who are cognitively impaired and need immediate access to assisted living?

[Susan Eng]

From the caregiver perspective it is thought that even people with dementia can age at home. However, the ability to do so requires both the expertise of properly trained home-care workers and adequate training for the family. Those two things in the case of dementia—even if there are no other co-morbidities—create the greatest amount of stress on caregivers and require the greatest amount of expertise among home-care workers, both of which are in short supply.

That is a particular challenge that is over and above helping somebody with kidney disease, for example.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Eng.

We'll now have to go to Ms. Quach.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Thank you, Madam Chair. I would also like to thank the witnesses who gave us the information. I'd especially like to thank Mr. Racine and Dr. Joanette. It is always good and rather nice to hear people speaking French. It's fairly rare here.

My question is for Mr. Racine. You said that it's very difficult for francophones to get care. Can you explain the process that patients need to go through to receive care? Are the steps lengthy? Does anyone help them? What type of person helps them?

[Jean-Luc Racine]

There is a process. It starts and often takes place in hospitals. Patients are admitted. In the provinces, it goes through access centres. Placement is more and more centralized. Patients go through access centres, the names of which differ from province to province.

As I explained in my presentation, the system unfortunately is under a lot of pressure. If we speak to social workers in hospitals, they tell us about the pressure they are under to place these patients elsewhere as quickly as possible to free up beds. It's understandable.

We are seeing that taking into account the language needs of patients is something that often becomes insignificant in the process. It's regrettable. Basically that's how we understand the process and it's how it was explained to us.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Which measures do you think would be a priority and should be implemented immediately to improve the situation?

[Jean-Luc Racine]

It's an important question. If I had the answer, I would be quick to give it to you.

One thing is for certain, we cannot disregard the problem. The goal of my presentation was to quite simply point out that we must not disregard this aspect of the situation. It's very important. Some measures can be adopted, but all the levels of government must show leadership and accept the fact that this aspect is important. It must be taken into account in the process. It's essential. Leadership does not always come easily.

Some health care facilities are also more sensitive than others when it comes to services provided in the hospitals. A little earlier, we were talking about home care. We don't always have the sensitivity to offer services in French. It works well in some regions, but in others it is very flawed. So it's not an easy situation. It's very complicated. Within the association, we realize that simply trying to find solutions requires a lot of resources.

[Dr. Yves Joanette]

If I may, your question is quite relevant and poses the issue of language. It's also a marker of culture. So there is the culture and the language. Right now, research is being done on language and culture. For example, in Alberta, Dr. Daniel Lai is working on the issue of Asian immigrant seniors who live in very specific situations in their community in terms of health care for the seniors. I go back to my obsession. I think if we want to find better solutions, they must be based on hard research. We need this hard research. Perhaps we need a co-ordinated national strategy with all the provinces and partners to encourage research on these issues.

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

My next question is for Mrs. Clark.

You spoke about the importance of social determinants of health. Last week, a symposium in Brazil looked at social determinants and the fact that we are spending 20% of the health budget on them. Could you tell me what type of policies would need to be developed to ensure that the services provided to seniors, especially in the area of chronic diseases, are fair for everyone?

[Patricia Clark]

You were talking about 20% of something, and I wasn't sure—20% of...?

[Anne Minh-Thu Quach, NDP, Beauharnois—Salaberry, QC]

Twenty per cent of the health budget is set aside for social determinants, including homelessness, unemployment and mental health.

[Patricia Clark]

On that, the social determinants of health are really important when we're looking at national policies, be it provincial or federal policies. Just looking at barriers for individuals is not sufficient.

There are eight or ten different factors in the determinants of health that are important to consider when we're looking at policy, and those factors need to be an integral part, whether it be policy at a local level or a provincial level or a national level. There's no point in saying we will implement something—as an example, let's say we're looking at transportation. That's an issue for some older adults, but there are many other issues in addition to transportation. The social determinants of health are critical when looking at policy, that they are included within any framework.

I'm probably not answering your question well enough because I wasn't quite sure what you were asking, but I don't want to ramble on.